Interview with Dr. Forgues




Dr. Peltos Interview with Dr. Matthew Forgues
Donald Pelto:  Good morning. This is Dr. Donald Pelto, and I'm with one of my colleagues here, Dr. Matthew Forgues. He is my actual optometrist, and I just got done with my eye appointment. We're going to talk a little bit about how diabetes can affect your eyes. So go ahead, Dr. Matt.
Matthew Forgues:  All right. Thank you, Dr. Pelto. Yeah, diabetes is actually the second leading cause of blindness in the eye, second only to macular degeneration. So it's a pretty serious condition. It's something that can be completely preventable if picked up early, so even in a setting like this early pick up and prevention is the key. At minimum people always ask us, "How often should we get our eyes checked with diabetes?" At minimum every 12 months, and we do a couple things. It's checking the vision but more importantly is looking at the health of the inside of the eye, which I'll show you some pictures here. So in essence with diabetes, how it affects the eyes, is it can actually affect the blood vessels within the eyes.
In a healthy retina there's a whole network of blood vessels that come right through and nourish the surface. With diabetes, essentially what happens here is the blood vessels in our eyes are prone to leak very easily. So if we get a little leakiness of blood vessels, as that resolves, you can be left with little scars.
Now right in this area here in the back of our eye is something called the macula. That's where we do our central vision, so the whole goal is to protect that area. Once we have damage in that area, it's very hard to get it back. So for example, in a routine exam someone might be seeing great, 20/20 vision if you will. We will again even do our routine screening.
If we see little things on the blood vessels going out here, it lets us know, "OK, that needs to stop and get treated before it affects that area." Now, obviously, diabetic control is the number‑one thing to do.
Donald:  OK. Just controlling the blood sugar.
Matthew:  Exactly. That's the key. But if there is any changes to a diabetic eye, there's a whole host of treatments now. Laser surgery is probably the first thing.
Donald:  Is that the same as LASIK, or is it a different..?
Matthew:  Completely different. LASIK is a refractive procedure on the front of the eye. This is a laser that actually seals broken blood vessels. So if you have a broken blood vessel in this area, they can seal it before it gets in and it affects different parts of the retina. So sometimes, with diabetes, it's obvious to an individual: "My vision's changing. I'm seeing things in my vision." We know something's going on. That's more the obvious things a patient may notice.
Unfortunately, when it's at that point, if you're noticing it, sometimes it's harder to stabilize an eye and keep someone seeing well. But the real key is, if you can pick it up before it actually starts affecting the vision and you have symptoms, you can keep someone's vision at the 20/20 level, like we just did.
Donald:  OK. Now, in terms of affecting the blood vessels, I talk a lot about how it affects the blood vessels in the feet and legs, where they get atherosclerosis and the clogging of the arteries. Is that the same type of way it affects the blood vessels in the eyes? Is it due to the high blood sugar, or is it due to the high blood pressure in the eye?
Matthew:  It's more the blood sugar. It does the exact same thing to the blood vessels in the eyes that it's doing in the rest of the body.
Donald:  And is there any way to reverse it, besides surgery?
Matthew:  There's no way to reverse it. Once the damage is there, it's just about stabilizing at that point, so you can't reverse the damage now. The exciting thing is there's new treatments coming down the pipeline to help reverse the damage. They're starting to do things like injections. There's something called the Avastin, which has done really well in stabilizing damage from macular degeneration on the retina. There's going to be more than just doing laser surgery, in that case.
Donald:  What we tend to see a lot of is I see people on, for example, renal dialysis, have neuropathy, and then I think it would almost go hand‑in‑hand. Those are the type of people that would tend to have...
Matthew:  They're a lot higher risk.
Donald:  ...higher risk of have this problem. The more severe it is in other areas of the body, I would think, it would tend to run hand‑in‑hand with the eyes. Correct? You see the sicker patients...
Matthew:  Oh, absolutely. No question about it. The statistics are a lot higher. But it's not always a given, either. Sometimes we'll see someone, blood sugar very well‑controlled, type 2, statistically low risk for diabetic retinopathy, and sure enough they'll have it.
Donald:  And they'll have it.
Matthew:  Likewise, sometimes I'll see someone will come in, really bad control of their diabetes, have all sorts of other problems. I'll look, and their retina will be fine. We always like to see a retina is in good shape.
Donald:  So the main reason people don't get it diagnosed earlier is because they're not seeing someone, because if they saw someone, most people would see that in their retina.
Matthew:  Oh, absolutely.
Donald:  So it's just lack of not having the annual appointments.
Matthew:  Yeah.
Donald:  Does insurance usually cover eye appointments like that?
Matthew:  Absolutely, yeah. It's routine. With diabetics, or anybody in general, you always want to check your insurance coverage for the routine. Part of a routine eye exam, we do a vision exam, typical glasses, contact lenses, make‑sure you're‑seeing‑well type exam. But we also do a battery of eye health tests. We check the pressure for glaucoma. We look inside of the eyes. Going back to this picture, during a routine exam, we look inside at the lens, where cataracts may be common. And then we study the retina for things like diabetes, macular degeneration, glaucoma. And that's pretty much with any routine exam, we would study the health.
Now, if someone has a history of diabetes, we sometimes do extra tests to study the retina in more detail, to make sure we're not missing anything. But interesting enough, a very common place people get diagnosed with diabetes, or the first indication they may have it, is a routine eye exam.
They come in, no symptoms, everything's been fine. We look at the retina and we might see a few leaky blood vessels. It kind of triggers us, "OK, we need to get them to their PCP, blood sugar checked." So the eye exam sometimes is some of the first indication.
So I guess the take‑home point is a routine eye exam is good for everybody. And we're even seeing now people come in every 12 months, and their PCPs are saying, "OK, you need to get your eyes checked every year."  But it's very important to pick it up early.
Donald:  OK. Well, thank you. Appreciate it.
Matthew:  No problem.